Nursing Elites

1. Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

• A. 1130 and 1330.
• B. 1330 and 1930.
• C. 1530 and 2130.
• D. 1730 and 2330.

Correct answer: C

Rationale: NPH insulin typically peaks 4-12 hours after administration, so a peak between 1530 and 2130 would be expected. Choice A (1130 and 1330) is too early for the peak effect of NPH insulin. Choice B (1330 and 1930) falls within the possible peak period but is not as accurate as choice C. Choice D (1730 and 2330) is too late for the peak effect of NPH insulin based on the typical peak timing.

2. Why is it important to control blood glucose levels in type 2 DM?

• A. Hypertension and kidney disease.
• B. Weight gain and obesity.
• C. Improved wound healing.
• D. Decreased cholesterol levels.

Correct answer: A

Rationale: Controlling blood glucose levels in type 2 DM is crucial to prevent complications. High blood glucose levels can lead to hypertension and kidney disease, as seen in diabetic nephropathy and diabetic nephropathy. These are common complications of uncontrolled diabetes. Weight gain and obesity (choice B) are influenced by factors such as diet and physical activity rather than blood glucose levels. Improved wound healing (choice C) is not directly related to blood glucose control but can be affected by it indirectly. Decreased cholesterol levels (choice D) are not a direct consequence of high blood glucose levels and are more related to dietary and lifestyle factors.

3. A nurse is assigned to care for a group of clients. On reviewing the clients' medical records, the nurse determines that which client is at risk for deficient fluid volume?

• A. A client with a colostomy
• B. A client with congestive heart failure
• C. A client with decreased kidney function
• D. A client receiving frequent wound irrigations

Correct answer: A

Rationale: The correct answer is A. Clients with a colostomy are at risk for deficient fluid volume due to the loss of fluid through the colostomy. In colostomy, there can be increased fluid loss through the stoma, which may lead to dehydration and electrolyte imbalances. Choices B, C, and D do not directly relate to the risk for deficient fluid volume. Clients with congestive heart failure are more prone to fluid overload rather than deficient volume. Clients with decreased kidney function are at risk for fluid retention, not deficient volume. Clients receiving frequent wound irrigations may be at risk for infection, but this does not directly indicate deficient fluid volume.

4. A client with hyperthyroidism is prescribed methimazole. The nurse should instruct the client that the purpose of this medication is to:

• A. Decrease thyroid hormone production
• B. Increase thyroid hormone production
• C. Suppress the immune system
• D. Prevent thyroid storm

Correct answer: A

Rationale: The correct answer is A: Decrease thyroid hormone production. Methimazole works by inhibiting the synthesis of thyroid hormones, specifically by blocking the enzyme responsible for this process. By reducing the production of thyroid hormones, methimazole helps to normalize the elevated levels seen in hyperthyroidism. Choices B, C, and D are incorrect. Choice B, 'Increase thyroid hormone production,' is inaccurate as methimazole actually decreases thyroid hormone production. Choice C, 'Suppress the immune system,' is unrelated to the mechanism of action of methimazole. Choice D, 'Prevent thyroid storm,' is not the primary purpose of methimazole; while it may help prevent worsening of hyperthyroidism, its main action is to reduce thyroid hormone levels.

5. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

• A. Antidiuretic hormone (ADH)
• B. Thyroid-stimulating hormone (TSH)
• C. Follicle-stimulating hormone (FSH)
• D. Luteinizing hormone (LH)

Correct answer: A

Rationale: Diabetes insipidus is a condition characterized by a deficiency of antidiuretic hormone (ADH). ADH plays a crucial role in regulating water balance by controlling the amount of water reabsorbed by the kidneys. Options B, C, and D are incorrect as they are not associated with diabetes insipidus. TSH (thyroid-stimulating hormone) is responsible for regulating thyroid function, while FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are involved in reproductive functions.

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